Your Guide to Rheumatoid Arthritis
This guide discusses the symptoms of rheumatoid arthritis, how to treat the condition, and how doctors diagnose it.
Key facts about rheumatoid arthritis
- Rheumatoid arthritis causes painful, stiff, and inflamed joints.
- The condition affects around 1.5 million adults in the U.S.
- Treatments for rheumatoid arthritis include medications and self-care.
- Rheumatologists diagnose the condition with physical exams, imaging, and blood tests.
Read on for more information about rheumatoid arthritis.
Rheumatoid arthritis is a type of arthritis that occurs when your immune system attacks your body’s healthy cells. This causes your joints to become inflamed.
You may experience painful, swollen joints in different parts of your body, but it typically affects the joints in your hands, wrists, and knees.
When the joint lining becomes inflamed, this can damage the joint tissue. This can result in chronic or long lasting pain.
Early symptoms of rheumatoid arthritis include tenderness and pain. To begin with, you may not notice any swelling of the joints.
As rheumatoid arthritis develops, however, you may experience the following symptoms:
- pain in multiple joints
- stiffness in multiple joints
- tender or swollen joints
- stiff joints first thing in the morning
- pain in the same joints on both sides of the body, such as both knees or both hands
Rheumatoid arthritis typically affects small joints first, such as those in your hands, wrists, or feet. You may experience flares of joint inflammation alongside periods of remission, during which you do not have any symptoms.
Although there is currently no cure for rheumatoid arthritis, it is possible to treat the condition with medication to slow it down and relieve the symptoms.
Treatment for rheumatoid arthritis typically involves disease-modifying antirheumatic drugs (DMARDs) and biologics (to prevent the condition from progressing too rapidly) and self-management techniques (to alleviate pain and discomfort).
Disease-modifying antirheumatic drugs
DMARDs slow down the progression of joint damage that rheumatoid arthritis can cause.
Your doctor may prescribe DMARDs alongside nonsteroidal anti-inflammatory drugs (NSAIDs) or low dose corticosteroids to help to reduce pain and swelling.
Common DMARDs include:
- methotrexate (Rasuvo, Otrexup, Rheumatrex, Trexall)
- leflunomide (Arava)
- hydroxychloroquine (Plaquenil)
- sulfasalazine (Azulfidine)
Your doctor may also recommend targeted synthetic DMARDs. These include tofacitinib, baricitinib, and upadacitinib.
Biologic response modifiers
Biologic response modifiers, or biologics, block chemical signals in the immune system that result in inflammation and damage to the joints or tissues. Biologics are either self-injections or infusions.
Your doctor may prescribe a biologic response modifier alongside a DMARD, as this combination of drugs can be more effective.
Common biologics approved by the Food and Drug Administration (FDA) include:
- tocilizumab (Actemra)
- certolizumab (Cimzia)
- etanercept (Enbrel)
- adalimumab (Humira)
- sarilumab (Kevzara)
- anakinra (Kineret)
- abatacept (Orencia)
- infliximab (Remicade)
- rituximab (Rituxan, MabThera)
- golimumab (Simponi)
Topical nonsteroidal anti-inflammatory drugs
Your doctor may recommend that you use topical NSAIDs. These are alternatives to oral NSAIDs and are available as gels, patches, and liquids.
You may benefit from topical NSAIDs if you:
- need to treat pain locally in small joints
- have a stomach that is sensitive to oral NSAIDs
- are at risk of heart failure or other heart conditions
Topical NSAIDs may not be suitable if you have sensitive skin or if you already take oral NSAIDs. Oral NSAIDs also typically work better at treating arthritis if multiple joints are inflamed.
It is important to follow the treatment plan provided by your doctor, which will typically include prescriptions for DMARDs and biologics.
Alongside medication, practicing self-care can help you reduce the pain and discomfort that occurs as a result of rheumatoid arthritis.
Apply hot and cold treatments
Cold therapy reduces swelling and pain. Apply a cool compress to painful areas to alleviate these symptoms.
Never apply ice packs or hot compresses directly to your skin.
Get plenty of rest
Make sure you get enough rest, particularly when your joints feel painful and swollen. Take breaks between periods of activity when you need to. This can also help reduce fatigue.
Getting around 150 minutes of low to moderate physical activity each week can help decrease pain and improve function.
If exercise causes too much pain in your joints, begin slowly and build up the amount you exercise you do when you find it more comfortable to.
Maintain a moderate weight
Maintaining a moderate weight can limit the progression of arthritis while also helping you stay active.
When required, weight loss helps reduce pressure on your joints. Losing around 5% of your weight if you are overweight can help reduce arthritic pain.
Eat a balanced diet
Eating a healthy, balanced diet can help you maintain a moderate weight, which can reduce pressure on your joints and allow you to stay active.
To improve your overall health and better manage your arthritis, eat a balanced diet that is rich in:
- fruits low in sugar
- fish high in omega-3 fatty acids, such as:
- wild salmon
Avoid eating processed foods and food that is high in saturated fats.
Supplements containing curcumin, turmeric, and omega-3 fish oil may help alleviate arthritis-related stiffness in the morning.
Contact your doctor before taking supplements or making any major changes to your diet.
Avoid overworking your joints
Certain activities, such as repeated bending of the knees or other repetitive movements, can add pressure to the joints. Try to avoid these repeated movements where possible.
Certain activities, such as high impact sports, can put more stress on weight bearing joints. Such sports can include:
- jumping exercises
Over time, this can cause more damage to your joints. Try to avoid these activities if you have rheumatoid arthritis.
Consider complementary therapies
Around 30–60% of people with rheumatoid arthritis use complementary therapies to help reduce arthritis pain and alleviate related stress. However, scientific research into whether or not complementary and alternative therapies provide any real or long-term benefits for arthritis is ongoing.
Complementary therapies include:
- herbal medicine
- tai chi
Contact your doctor if you are considering complementary or alternative therapies.
Around 1.5 million adults in the U.S. have rheumatoid arthritis. This is around 0.6% of the population.
Autoimmune rheumatic conditions, including rheumatoid arthritis, affect around 1 in 12 females and 1 in 20 males.
In order to diagnose rheumatoid arthritis, a rheumatologist will use information from your medical history, physical exams, imaging studies, and blood tests.
Your doctor will first ask you questions about your symptoms. These questions might include:
- What symptoms are you experiencing?
- When did your symptoms begin?
- Do your symptoms come and go?
- How severe are your symptoms?
- Do certain actions or movements make your symptoms worse?
- Do you have any family members with rheumatoid arthritis or another autoimmune disease?
Your doctor may then carry out a physical exam. They will look for:
- tender joints
- joint pain
- joint warmth
- any limited movement
- bumps under the skin
They will then carry out X-rays and laboratory tests before reaching a diagnosis.
Imaging for rheumatoid arthritis
Imaging tests can reveal if the ends of the joint bones have worn down. These tests can include:
If your rheumatoid arthritis is in an early stage, there may not be any damage to the bone yet.
Blood tests for rheumatoid arthritis
Your doctor can arrange for a blood test to see if there are high levels of inflammation or any antibodies present that are linked to rheumatoid arthritis.
If you have arthritis, your blood test may show antibodies to cyclic citrullinated peptides, or anti-CCPs. These are present in around 60–70% of people with rheumatoid arthritis, and this means that the type of arthritis is seropositive arthritis.
Seronegative rheumatoid arthritis occurs when you have rheumatoid arthritis but antibodies do not show up in the blood test.
Rheumatoid factor is an antibody that shows up for 80% of people during some stage of the condition. However, it only appears in around 30% of blood tests for early stage rheumatoid arthritis.
High levels of erythrocyte sedimentation can indicate inflammation. High levels of C-reactive protein can also suggest inflammation.
Seropositive and seronegative rheumatoid arthritis
Treatments for seropositive and seronegative rheumatoid arthritis do not differ. However, the presence or absence of anti-CCPs in your blood may indicate future changes in diagnosis.
If you have CCP antibodies in your system, you are at higher risk of arthritis progression and erosive joint damage.
For example, if you have seronegative rheumatoid arthritis, you may later develop a skin rash. If this happens, your doctor may change your diagnosis to psoriatic arthritis. It is also possible to confuse osteoarthritis with seronegative rheumatoid arthritis.
Rheumatoid arthritis occurs when your immune system causes healthy tissue to become inflamed. This happens when it mistakes it for a foreign body, such as bacteria or a virus.
When inflammation persists, it causes damage to the joints, and this is often irreversible.
Medical professionals do not know the exact reason that the immune system mistakes healthy tissue for foreign bodies. However, some factors — such as certain genes or smoking — make you more likely to experience rheumatoid arthritis.
Although medical professionals do not know the exact cause of rheumatoid arthritis, there are certain risk factors that make you more likely to develop the condition.
Risk factors for rheumatoid arthritis include:
- being over the age of 60 years
- being born with specific genes, including human leukocyte antigen (HLA) class II genotypes
- having obesity
Females are also two to three times more likely to develop rheumatoid arthritis than males. A female who has never given birth may also be more likely to develop this condition.
As environmental factors can contribute to the development of rheumatoid arthritis, the inheritability of the condition is unclear.
However, it is possible that variations in HLA genes contribute to your likelihood of developing the condition. There is a particular focus on the HLA-DRB1 gene.
Twin studies suggest that there is around a 60% chance of inheriting rheumatoid arthritis. However, more research is necessary.
There are numerous complications that can occur as a result of rheumatoid arthritis. These can affect both your health and your quality of life.
- eye problems, such as:
- dry eyes
- sensitivity to light
- difficulty seeing
- gum inflammation or infection
- rheumatoid nodules, or small lumps under the skin of bony areas
- shortness of breath
- inflamed blood vessels
- a reduced number of red blood cells, which can lead to anemia
- nerve damage
- damage to the heart muscles or lining of the heart
- heart failure
- valve disease
- coronary artery disease
- organ damage
- lung disease
As painful joints can make it difficult to keep active, this can lead to increased risks of:
Contact your doctor if you experience any of these complications or if you feel that rheumatoid arthritis is significantly affecting your quality of life.
Living with a chronic condition such as rheumatoid arthritis can be overwhelming and result in a low or impaired quality of life. Symptoms, potential complications, and treatment costs can have physical, emotional, and financial impacts.
Around 16.8% of people with rheumatoid arthritis have depression. This compares with 6.7% of the general adult population in the U.S. who have a major depressive disorder and 1.5% who have a persistent depressive disorder.
Around 25–50% of people with rheumatoid arthritis are unable to work within 10–20 years following diagnosis. This can affect you financially, particularly if you have rheumatoid arthritis earlier in life.
If you have rheumatoid arthritis, you might also face higher healthcare expenses and more treatment costs.
However, the Patient Protection and Affordable Care Act was signed in March 2010, and this helps ensure coverage and access to health insurance for people with rheumatoid arthritis and other types of arthritis.
Contact a doctor as soon as you notice early symptoms of rheumatoid arthritis. You may notice joint tenderness and pain before you notice any swelling or inflammation.
The sooner your doctor or rheumatologist diagnoses rheumatoid arthritis, the sooner you can begin treatment. Early treatment can help slow down the progression of rheumatoid arthritis.
See below for more frequently asked questions about rheumatoid arthritis. These questions have been answered by Dr. Margaret R. Li, M.D., FACR.
What is the difference between rheumatoid arthritis and osteoarthritis?
Rheumatoid arthritis is an autoimmune disease wherein the immune system mistakenly attacks joints and sometimes organs, causing inflammation. It causes symmetric arthritis, leading to warm, swollen, and tender joints.
Early detection and treatment are important to slow down the progression of the disease as well as joint deformities. The majority of people with rheumatoid arthritis are ages 30–50 years, but the condition can occur in children as well as older individuals.
Osteoarthritis is wear-and-tear arthritis. Advanced age and heavy use of the joints are major risk factors for developing osteoarthritis.
Treatment is mainly directed toward controlling pain and maintaining joint mobility. Unlike with rheumatoid arthritis, there are no effective medications to prevent the progression of the disease. In some people, joint replacement may be an option for advanced osteoarthritis.
Is rheumatoid arthritis caused by stress?
It is unclear if rheumatoid arthritis is provoked by stress. Some studies have found higher levels of inflammatory protein markers in people with rheumatoid arthritis and increased interpersonal stress. Some studies have found a correlation with major stress events directly preceding the diagnosis of rheumatoid arthritis, while others have not.
Prospective longitudinal studies will need to be done on this important topic.
Does rheumatoid arthritis go away?
Rheumatoid arthritis is a chronic disease. There is currently no cure, but there are effective treatments that can put the condition into remission.
Can COVID-19 cause rheumatoid arthritis?
Infections, in general, can provoke the onset of autoimmune inflammatory arthritis due to a hyperactive response of the immune system and the release of pro-inflammatory mediators.
There have been reported cases of people developing new-onset rheumatoid arthritis with positive blood markers who previously tested negative for the condition.
More studies are needed on this rapidly evolving topic.
Does rheumatoid arthritis make you tired?
Fatigue is very common in rheumatoid arthritis. Around 90% of people with the condition report fatigue as the main factor causing low mood and depression. Fatigue is multifactorial: Sleep disturbance from chronic pain, as well as cognitive and social factors, can contribute to fatigue.
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Rheumatoid arthritis causes your joints to become inflamed and painful. It typically affects smaller joints such as the hands and feet, but it can also affect other areas of your body, such as your knees and hips.
Symptoms of rheumatoid arthritis include joint tenderness, pain, and stiffness. You may experience flares of rheumatoid arthritis between periods of respite.
Contact your doctor if you experience any symptoms of rheumatoid arthritis. They may prescribe DMARDs and biologics and advise on self-care tips that you can practice at home to alleviate pain and discomfort.